the myth of sisyphus

post call today after a long, sleepless night in the PICU. i have this vague recollection of leaving the bedside at one point to brush my teeth, but otherwise, not at all.

i am left with a sense of defeat, as if i have been foolishly trying to hold water in a sieve. no matter how much water i put in, it all just flows out again, mocking my efforts and highlighting my naive, all-too-tentative confidence that i know what i am doing.

as the sun began to appear on the horizon, the nurses and i took a moment to breathe and enjoy the beauty. she was momentarily improving, but my intuition was that this, too, would pass.

these are the patients that leave you wondering why it is that we do what we do, when it just seems futile? as if god, if you believe in such an entity, just has a different plan? you struggle to eek out some small iota of change. but in the end, the DIC, ARDS, and sepsis win, just as sisyphus' rock inevitably rolls back down the hill. yet, he rolls it back up again.

i have blogged in the past about other chronically ill children who have passed away, some with more peaceful deaths than others. as a general rule, i support a family's desire to do everything possible. so what do you do in cases where respecting the family's wishes feels unethical? when it feels like every intervention is painful and only serves to prolong the patient's suffering?

when i came home this morning, the sun was shining. spring is in full force here and it is breathtaking. i fell asleep and did not dream. i awoke this afternoon to lightning, thunder and the sound of sheets of rain falling on my metal roof. as i sit here typing, the rain has passed, the storm clouds are receding to the east, the sun is peeking through the clouds again over the greens. mother nature as metaphor.